Phase 1-Physical Therapy: Patients with Lyme Disease, ME/CFS and/or POTS

Physical Therapy- Phase 1 

Check Vital Signs

• Blood Pressure: Normal is a relative term but in general males run a little higher than females and BP will increase with age and height. Standard Blood Pressure (BP) is 120:80. Each 10 point deviation above that is defined as varying degrees of Hypertension or High Blood Pressure. Each 10 point deviation below 120:80 is defined as Hypotension or Low Blood Pressure. A 20 point drop may lead to dizziness or syncope and exercise would not be appropriate. 
• Oxygen Level: Can be checked with a Pulse Oximeter which will show the percentage of oxygen (SpO2) in the blood stream and the heart rate or pulse rate (PR). Normal SpO2 is between 95-100%. Generally exercise would not be appropriate below 95%. Oxygen is normally administered when the SpO2 drops below 93%. If a patient has low hemoglobin they will be more sensitive to slight drops in SpO2. Signs to watch for: 
• Cyanosis (blue lips, fingers, toes, nail beds) 
• Dyspnea (shortness of breath) 
• Dizziness, lightheadedness or loss of acuity 
• Labored breathing 
• Loss of consciousness 
• Heart Rate: Normal Resting heart rate for adults is between 60-100 beats per minute.
• Note: If upon standing a patient has a drop in blood pressure and a sudden increase in heart rate  of 30 beats or more followed by dizziness they should be evaluated for Postural Orthostatic Tachycardia Syndrome (POTS). POTS is present in about 50% of patients with Chronic Fatigue Syndrome. 

Education

• Teach patient or caregiver how to monitor vital signs at home and keep a daily log.
• Teach patient to raise slowly from bed and to sit with feel flat on the floor until blood pressure normalizes before getting out of bed. 
• Teach patient to recognize signs of low blood pressure and how to take precautions to prevent falling when dizzy or lightheaded. 

Stretching 

• Perform gentle stretching of all four extremities, back and neck. 
• Assess patients mobility level and design a custom 4-8 step home stretching program that takes between 10-15 minutes to complete. Stretching can be done independently or with the assistance of a caregiver. (examples are pictured below)
• Note: Many POTS and CFS patients can not tolerate even limited exercise. It is important that they do not over exert themselves as it will make their symptoms worse. A simple beginner stretching program may be all that some patients can tolerate. 

Pain Management

• Most patients will point to where they hurt. If possible massage should focus on these areas of pain and tenderness.  
• Many patients with Lyme, ME/CFS and fibromyalgia will have full body pain making it more difficult to treat. 
• Initially, I recommend moist heat and a light massage focusing on common areas of pain (pictured below). Effleurage or Myofacial Release works well. 
• Make note of any swollen Lymph Nodes and notify the treating physician. 
• For a list of 10 Tips for Managing Chronic Pain at Home see my recommendations here. 

Lymph Massage and Lymph Drainage

• If the patient has swollen Lymph nodes it is important to know if this is new or chronic. 
• Once the patient is medically cleared, I recommend Lymph Massage and/or the use of  an automated Lymphedema Pump. I have found patients with POTS respond really well to this. 

Energy Conservation

• Teach patients how to conserve energy in their activities of daily living. 
• Offer suggestions based upon what they are having the most difficulty with (e.g. Shower bench, long handle reacher, slip-on shoes...) 
• Mental Exertion causes as much fatigue for some CFS patient as Physical Exertion. Life for these patient is all about calculated energy conservation. For people who have CFS, their energy level is like an old cell phone battery. It takes forever to charge and it depletes quickly. 

All Physical Therapist are qualified to treat ME/CFS and Fibromyalgia, however I recommend finding a PT with experience in Pain Management and a good understanding of the complexities surrounding Lyme and/or Chronic Fatigue Syndrome. To find a PT visit the APTA's website for a list of providers within your zip code. Asking friends and medical providers is another great way to find a qualified PT. 

*My next post will be on Phase 2 Physical Therapy which will include aquatic therapy, yoga and non-aerobic exercise.